For sex workers in San Pedro Sula, Honduras, access to medical and psychological care has been limited by social stigma and lack of services. The San Pedro Sula clinic run by Doctors Without Borders/Médecins Sans Frontières (MSF) provides comprehensive care in a supportive environment, empowering women to positively influence their communities. MSF opened the clinic in July 2021 to improve access to care for sex workers and the LGBTQI+ community. Located in the center of the city, the clinic provides primary medical and psychological care with a focus on sexual and reproductive health. It also offers a priority service to comprehensively care for victims and survivors of sexual violence.
Finding the courage to speak out
Nadia,* a sex worker in Honduras, has overcome many challenges in her life from a very young age, including abuse and addiction.
“I was out of touch with reality, I was in a messy world, and everything was messed up—my whole body, my health,” she said. But there were few available options for help.
Like many parts of the world, stigma in Nadia’s community and society at large impact the sexual health of women. Not all people accept a woman’s freedom to choose her own lifestyle.
“In our society, a woman’s sexual life should only be active within marriage, and sometimes it is not possible,” said Nadia. “Some stigmatize young people and do not allow them to access prevention services. We should be a little more realistic.”
Nadia said this stigma, and the associated fear, can be dangerous. If a woman is afraid to speak up about what she needs in order to make sex safer; if a condom fails and she remains silent, it can prevent her from managing any complications that follow.
“Sometimes we don't have the opportunity to talk about our sexuality or our fears,” she said. “So, people don’t look for help in time, and can even find death.”
Finding unconditional acceptance
To support the sex worker and LGBTIQ+ communities of San Pedro Sula, MSF established a dedicated clinic in this northern Honduran city in 2021.
“In this clinic, I found that you can speak openly,” said Nadia. “But there are places where there are health staff whose treatment [of you] is not the same. They give you medical attention, but they are also giving you their point of view on what you should, or should not do, with your life.”
“It has been a blessing to find this place, where I can find everything: prevention and control of HIV, syphilis, and sexually transmitted diseases, family planning…psychological help and social support,” Nadia said. “I realized that everything has a price, but that taking care of myself was priceless and I began to value that more.”
Learning to take care of ourselves
Because of her experiences, Nadia speaks out in support of education for mothers and daughters to break through the barriers to services and information.
“Sex education should be available for children of a certain age, and for mothers to allow their daughters to take care of themselves,” she said.
Ruth,** another sex worker in San Pedro Sula, also believes in self-care: controlling one’s health means being up to date with treatment, with medication, and coming to the clinic when you feel bad.
Ruth highlights the importance of feeling invited into, and accepted in, a health care center. MSF health promoters visited Ruth and other women in her neighborhood, explaining that the clinic’s doors were open to them, that medicine was free, and tests were available."They told us how to prevent [illnesses], how to take care of ourselves. I felt good,” she said.
Mental health is a key part of MSF’s comprehensive care package. “When I came to the clinic in the first few days, I did come in quite depressed,” said Ruth. “I felt that my life no longer made sense. I saw the psychologist because of everything I went through, and it helped me because…it has not been easy.”
Ruth would like to tell other women—who she calls “these beautiful girls”— to “take care of themselves, to protect themselves more than anything, and to be up to date with their [medical] tests and to come for a consultation.”
“And secondly, to support all the women who need it, who are depressed or similar, that's why the clinic is there, and it helps.”
Sharing sexual well-being messages across generations
Ruth and Nadia have both faced and overcome many challenges. “Personally, I suffered too much during the time I didn't take care of myself,” said Nadia.
“I decided and learned through therapy that this is my life, that it is my responsibility, that it is the legacy that I am going to leave to my daughters.
“As a mother I would like my daughters to walk down the aisle in white; but actively talking about sexuality with our daughters is healthy and for [my family] we have decided not to fall into the [the trap of] taboo.
“Sex is beautiful, it is wonderful, it is something that as a human being we must fully enjoy. But to fully enjoy it, you must take care of yourself.”
* Surname has been withheld by request.
** Name has been changed by request.